Bioreactance reliably detects preload responsiveness by the end-expiratory occlusion test when averaging and refresh times are shortened
Abstract Background The end-expiratory occlusion (EEXPO) test detects preload responsiveness, but it is 15 s long and induces small changes in cardiac index (CI). It is doubtful whether the Starling bioreactance device, which averages CI over 24 s and refreshes the displayed value every 4 s (Starlin...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2021-08-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-021-00920-7 |
| _version_ | 1830515498581753856 |
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| author | Francesco Gavelli Alexandra Beurton Jean-Louis Teboul Nello De Vita Danila Azzolina Rui Shi Arthur Pavot Xavier Monnet |
| author_facet | Francesco Gavelli Alexandra Beurton Jean-Louis Teboul Nello De Vita Danila Azzolina Rui Shi Arthur Pavot Xavier Monnet |
| author_sort | Francesco Gavelli |
| collection | DOAJ |
| description | Abstract Background The end-expiratory occlusion (EEXPO) test detects preload responsiveness, but it is 15 s long and induces small changes in cardiac index (CI). It is doubtful whether the Starling bioreactance device, which averages CI over 24 s and refreshes the displayed value every 4 s (Starling-24.4), can detect the EEXPO-induced changes in CI (ΔCI). Our primary goal was to test whether this Starling device version detects preload responsiveness through EEXPO. We also tested whether shortening the averaging and refresh times to 8 s and one second, respectively, (Starling-8.1) improves the accuracy of the device in detecting preload responsiveness using EEXPO. Methods In 42 mechanically ventilated patients, during a 15-s EEXPO, we measured ∆CI through calibrated pulse contour analysis (CIpulse, PiCCO2 device) and using the Starling device. For the latter, we considered both CIStarling-24.4 from the commercial version and CIStarling-8.1 derived from the raw data. For relative ∆CIStarling-24.4 and ∆CIStarling-8.1 during EEXPO, we calculated the area under the receiver operating characteristic curve (AUROC) to detect preload responsiveness, defined as an increase in CIpulse ≥ 10% during passive leg raising (PLR). For both methods, the correlation coefficient vs. ∆CIpulse was calculated. Results Twenty-six patients were preload responders and sixteen non preload-responders. The AUROC for ∆CIStarling-24.4 was significantly lower compared to ∆CIStarling-8.1 (0.680 ± 0.086 vs. 0.899 ± 0.049, respectively; p = 0.027). A significant correlation was observed between ∆CIStarling-8.1 and ∆CIpulse (r = 0.42; p = 0.009), but not between ∆CIStarling-24.4 and ∆CIpulse. During PLR, both ∆CIStarling-24.4 and ∆CIStarling-8.1 reliably detected preload responsiveness. Conclusions Shortening the averaging and refresh times of the bioreactance signal to 8 s and one second, respectively, increases the reliability of the Starling device in detection of EEXPO-induced ∆CI. Trial registration: No. IDRCB:2018-A02825-50. Registered 13 December 2018. |
| first_indexed | 2024-12-22T03:23:41Z |
| format | Article |
| id | doaj.art-cca8828719ee4dc8b1f12d17fb62ad12 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-22T03:23:41Z |
| publishDate | 2021-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-cca8828719ee4dc8b1f12d17fb62ad122022-12-21T18:40:39ZengSpringerOpenAnnals of Intensive Care2110-58202021-08-0111111010.1186/s13613-021-00920-7Bioreactance reliably detects preload responsiveness by the end-expiratory occlusion test when averaging and refresh times are shortenedFrancesco Gavelli0Alexandra Beurton1Jean-Louis Teboul2Nello De Vita3Danila Azzolina4Rui Shi5Arthur Pavot6Xavier Monnet7Service de Médecine Intensive-Réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMASService de Médecine Intensive-Réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMASService de Médecine Intensive-Réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMASService de Médecine Intensive-Réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMASResearch Support Unit, Department of Translational Medicine, Università degli Studi del Piemonte OrientaleService de Médecine Intensive-Réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMASService de Médecine Intensive-Réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMASService de Médecine Intensive-Réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMASAbstract Background The end-expiratory occlusion (EEXPO) test detects preload responsiveness, but it is 15 s long and induces small changes in cardiac index (CI). It is doubtful whether the Starling bioreactance device, which averages CI over 24 s and refreshes the displayed value every 4 s (Starling-24.4), can detect the EEXPO-induced changes in CI (ΔCI). Our primary goal was to test whether this Starling device version detects preload responsiveness through EEXPO. We also tested whether shortening the averaging and refresh times to 8 s and one second, respectively, (Starling-8.1) improves the accuracy of the device in detecting preload responsiveness using EEXPO. Methods In 42 mechanically ventilated patients, during a 15-s EEXPO, we measured ∆CI through calibrated pulse contour analysis (CIpulse, PiCCO2 device) and using the Starling device. For the latter, we considered both CIStarling-24.4 from the commercial version and CIStarling-8.1 derived from the raw data. For relative ∆CIStarling-24.4 and ∆CIStarling-8.1 during EEXPO, we calculated the area under the receiver operating characteristic curve (AUROC) to detect preload responsiveness, defined as an increase in CIpulse ≥ 10% during passive leg raising (PLR). For both methods, the correlation coefficient vs. ∆CIpulse was calculated. Results Twenty-six patients were preload responders and sixteen non preload-responders. The AUROC for ∆CIStarling-24.4 was significantly lower compared to ∆CIStarling-8.1 (0.680 ± 0.086 vs. 0.899 ± 0.049, respectively; p = 0.027). A significant correlation was observed between ∆CIStarling-8.1 and ∆CIpulse (r = 0.42; p = 0.009), but not between ∆CIStarling-24.4 and ∆CIpulse. During PLR, both ∆CIStarling-24.4 and ∆CIStarling-8.1 reliably detected preload responsiveness. Conclusions Shortening the averaging and refresh times of the bioreactance signal to 8 s and one second, respectively, increases the reliability of the Starling device in detection of EEXPO-induced ∆CI. Trial registration: No. IDRCB:2018-A02825-50. Registered 13 December 2018.https://doi.org/10.1186/s13613-021-00920-7FluidCardiac indexMonitoringPassive leg raisingFluid challengeHeart lung interactions |
| spellingShingle | Francesco Gavelli Alexandra Beurton Jean-Louis Teboul Nello De Vita Danila Azzolina Rui Shi Arthur Pavot Xavier Monnet Bioreactance reliably detects preload responsiveness by the end-expiratory occlusion test when averaging and refresh times are shortened Annals of Intensive Care Fluid Cardiac index Monitoring Passive leg raising Fluid challenge Heart lung interactions |
| title | Bioreactance reliably detects preload responsiveness by the end-expiratory occlusion test when averaging and refresh times are shortened |
| title_full | Bioreactance reliably detects preload responsiveness by the end-expiratory occlusion test when averaging and refresh times are shortened |
| title_fullStr | Bioreactance reliably detects preload responsiveness by the end-expiratory occlusion test when averaging and refresh times are shortened |
| title_full_unstemmed | Bioreactance reliably detects preload responsiveness by the end-expiratory occlusion test when averaging and refresh times are shortened |
| title_short | Bioreactance reliably detects preload responsiveness by the end-expiratory occlusion test when averaging and refresh times are shortened |
| title_sort | bioreactance reliably detects preload responsiveness by the end expiratory occlusion test when averaging and refresh times are shortened |
| topic | Fluid Cardiac index Monitoring Passive leg raising Fluid challenge Heart lung interactions |
| url | https://doi.org/10.1186/s13613-021-00920-7 |
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